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The assessment of the important changes that occurred in late third and second millennia societies across Europe often emphasizes changes in technology and the emergence of associated objects and art forms, changes in burial rites, and developments in economic practices. Notions relating to the evolution of homo economicus dominate many of the discourses, and the evidence for increased long-distance trade / contact across Europe is used to bolster this assessment. These themes are underpinned by an obsession with ever-refined chrono-typological phases. In an attempt to present a more socially embedded perspective, this paper considers the changes that occurred in the uses of the high-altitude, sub-alpine, and alpine zones in the southern French Alps during the third and second millennia BC. From c. 2500 BC onwards, there was a fundamental change in the use of and engagement with this landscape. The first substantial stone-built pastoral structures at high altitude (2000 m and above), appear at this time. This departure in the use and structuring of the alpine space would have included concomitant changes in the nature of mobility, notions of territory, and memories associated with this area. The assessment of the important changes that occurred in late third and second millennia societies across Europe often emphasizes changes in technology and the emergence of associated objects and art forms, changes in burial rites, and developments in economic practices. Notions relating to the evolution of homo economicus dominate many of the discourses, and the evidence for increased long-distance trade / contact across Europe is used to bolster this assessment. These themes are underpinned by an obsession with ever-refined chrono-typological phases. In an attempt to present a more socially embedded perspective, this paper considers the changes that occurred in the uses of the high-altitude, sub-alpine, and alpine zones in the southern French Alps during the third and second millennia BC. From c. 2500 BC onwards, there was a fundamental change in the use of and engagement with this landscape. The first substantial stone-built pastoral structures at high altitude (2000 m and above), appear at this time. This departure in the use and structuring of the alpine space would have included concomitant changes in the nature of mobility, notions of territory, and memories associated with this area. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe., Methods: A questionnaire was sent to ACHD cardiologists from 34 European countries., Results: Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001)., Conclusion: Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To report the experience of 23 tertiary referral European Centres on transcatheter closure of congenital ventricular septal defects (VSD)., Methods and Results: Implantation of transcatheter devices was attempted in 430 patients (pts) with congenital VSDs until July 2005. The following anatomic types were present: 119 muscular, 250 perimembranous, 16 multiple, 45 residual post-surgery. Median VSD size was 7 mm (range 3-22), fluoroscopy time 33 min (range 3-146). Devices implanted were Amplatzer muscular or membranous devices in 364, PDA devices in 12, ASD devices in seven, Starflex in seven, and coils in nine patients. Procedure was successful in 410 cases (95%)., Complications: device embolization in five cases (surgery in two, catheter retrieval in three), aortic regurgitation in 14 cases (two of which requiring surgery), tricuspid regurgitation in 27 cases (no surgery was necessary), minor rhythm disturbances in 10 pts, death in one patient, complete heart block (cAVB) in 16 pts [perimembranous 12 of 250 (5%), muscular one of 119 (0.8%), residual post-surgery VSD three of 45 (6.7%)]. CAVB was transient in six patients, requiring permanent pace-makers in 10 cases (3.8%) (six early, four late). In the multivariate analysis, the only variable associated with a risk of the occurrence of complication was age (P=0.012) and weight (P=0.0035). In the univariate analysis, risk factors for the development of cAVB were, device type (P=0.03) and VSD location (P=0.05). After the multivariable Cox proportional hazards analysis, no risk factor was found., Conclusion: Transcatheter closure of congenital VSDs offers encouraging results. COMPLICATIONS are limited; the most relevant one seems to be the device related to cAVB in perimembranous VSD. More experience and long-term follow-up are mandatory to assess safety and effectiveness of this procedure as an alternative to conventional surgery.